血液灌流治疗重症过敏性紫癜17例疗效分析

摘要

Objective To observe the clinical efficacy of hemoperfusion for treatment of severe Henoch-She(o)nlein purpura. Methods From January 2008 to May 2011, 37 pediatric patients with severe Henoch-Sch(o)nlein purpura were enrolled and randomly divided into control group (20 cases) and treatment group (17 cases). The patients in control group were treated with conventional treatment ( anti-inflammatory, antianaphylaxis, anticoagulation, symptomatic treatment), and the patients in treatment group were treated with conventional treatment plus hemoperfusion. All patients were treated for 10 days. The clinical symptoms. T cell subsets, serum IgA, IL-6, IL8, urinary albumin. Retinol binding protein ( RBP) , and N-acetyl-beta-D-glucosaminidase ( NAG) were compared between two groups. Results The time taken to improve of severe Henoch-Sch(o)nlein purpura related symptoms such as abdominal pain, bloody stool, rash and hematuria in therapy group was shorter than in control group (P < 0.05). The levels of CD3, CD4 and CD4/CD8 were elevated significantly in treatment group than those in control group (P < 0.05). The level of IL-8 were reduced significantly in treatment group than that in control group (P < 0.05). The levels of microal-buminuria, retinol binding protein and N-acetyl-β-D-glucosaminidase in urine were reduced significantly in treatment group than those in control group (P < 0.05). Conclusions Hemoperfusion is a new approach for adjunctive treatment of Henoch-Sch(o)nlein purpura. The elimination of blood inflammatory mediators may be a possible way for hemoperfasion to alleviate clinical symptoms and kidney pathological injuries in Henoch-SchSnlein purpura.%目的 观察血液灌流辅助治疗重症过敏性紫癜的疗效.方法 将重症过敏性紫癜患儿37例随机分为对照组(20例)、治疗组(17例).对照组患儿采用常规治疗(抗炎、抗过敏、抗凝及对症处理),治疗组患儿在常规治疗基础上加用血液灌流,两组患儿均治疗10 d.比较两组患儿治疗前后的临床症状及T细胞亚群、血清IgA、IL-6、IL-8、尿微量白蛋白、尿视黄醇结合蛋白(RBP)、N-乙酰-β-D-氨基葡萄糖苷酶(NAG).结果 治疗组患儿腹痛及血便、皮疹、肉眼血尿等临床症状改善时间均较对照组缩短(P＜0.05)；CD3、CD4、CD4/CD8较对照组高,而IL-8较对照组低(P均＜0.05)；尿微量白蛋白、尿RBP、NAG较对照组低(P＜0.05).结论 血液灌流是辅助治疗重症过敏性紫癜的一种有效的新方法,可能通过免疫调节、清除血液中的炎症递质来缓解临床症状、减轻肾损伤.